Research brief: The impact of out-ofpocket costs on abortion care access
S e p t e m b e r 2016
O v e rv i e w
The decision to have a child has significant implications for
a woman’s financial well-being, educational attainment, and
workforce participation. Access to affordable, comprehensive
reproductive health care services, inclusive of abortion care,
ensures that women and their families, regardless of financial and
insurance status, can make this decision when they are ready.
covered by public health insurance programs, restrictions in
coverage increase their socioeconomic disadvantage. Addressing
high OOP costs will go a long way to ensuring all women have
access to safe and affordable abortion care services and to
reducing negative impacts on household security for women and
their families as they struggle to find OOP funds.
A 2014 Commonwealth Fund study of high income countries
ranked the US healthcare system last in terms of access and
equity, due in part to high out-of-pocket spending requirements1.
The average US resident spent $1,074 out-of-pocket (OOP) in
copayments for doctor’s office visits, prescription drugs, health
insurance deductibles, and other health care costs in 20131.
These expenses, when viewed in the context of findings from
a government survey showing that “47% of Americans were
unable to come up with $400 in an emergency using cash or
funds in their existing checking/savings accounts or on a credit
card that they could pay in full by the next billing cycle”2, help
explain associations found between OOP costs and public health
indicators such as decreased treatment adherence3,4, and delayed
‘needed’ care5.
For this report, we reviewed published literature, papers under
submission, and other publicly available information on the costs
of abortion care to document:
• the current OOP cost landscape for abortion in the United
States;
• factors contributing to OOP costs for abortion services at the
policy, health care provider, and individual level
• the impact of OOP expenses on US women’s abortion access;
and
• public health and policy strategies that would move us towards
reducing OOP costs for abortion care
Average OOP costs for an abortion range from $397 for a first
trimester abortion to $854 for a second-trimester abortion6, a cost
that—based on the report cited above—is out of reach for the
average American. Given that 42 percent of women seeking an
abortion have household income below the federal poverty level
in the United States7, these high OOP costs result in inequitable
access to abortion services and an exacerbation of existing
reproductive health disparities.
Health insurance funding and coverage bans in the United States
limit access to care for women who cannot pay the significant
OOP costs for these services. Congress has enacted numerous
policies that prohibit funding of abortion at the federal level,
impacting nearly all women who rely on federal programs for
their health care needs. One such policy is the Hyde Amendment
which bars the federal Medicaid health insurance program from
covering abortion care. Currently, 52% of women covered by
Medicaid— approximately 7.4 million women—live in states that
also extend these restrictions to their state Medicaid program,
providing abortion coverage for only those women who meet the
highly limited Hyde exceptions—women whose lives are in danger
or whose pregnancies are the result of rape or incest8. Because
low-income women and women of color are disproportionately
Our findings suggest that OOP costs play a fundamental role, one
that is often underestimated, in the discussion of abortion access
in the United States.
Findings
OOP costs for abortions in the United States
The majority of women seeking abortion care are between the
ages 20-29, non-White, and have had at least one previous birth9.
Data from the Guttmacher Institute’s most recent abortion patient
survey found that 49% of abortion patients had incomes less
than 100% of the federal poverty level. Approximately 72% of
abortion patients reported having some type of health insurance
and 24% used Medicaid coverage to pay for their abortion9.
Regardless of insurance coverage, 53% of abortion patients in the
Guttmacher survey reported paying OOP for their abortion9. This
proportion is similar to results from a national survey conducted
between 2008 and 2009 of US abortion patients (n=9493) that
reported 57% paid OOP for abortion services7; qualitative
research with smaller selected samples of women has shown that
a higher proportion
of women—upwards
Irrespective of insurance coverage,
of 75%— paid OOP
53% of US abortion patients paid
for their abortion care
for their abortion themselves
and that proportion
varied by state10,11.
1
In the articles we reviewed, costs for a clinic-based abortion in
the United States were most often provided as mean and median
costs; costs varied by gestational age, abortion procedure, type
of facility, and caseload6,11-17. In general, costs increased with
gestational age13,17, were most expensive at physician’s offices13,
and least expensive at facilities with larger caseloads13. Data from
the Turnaway study, a study of women seeking abortion care at
30 facilities across the United States17, found that abortion costs
on average were $506 for a first-trimester aspiration procedure,
and $461 for a first-trimester medication abortion. For abortions
at 14-19 weeks, the average cost was $860, while abortions 20
weeks and over cost on average $1874.
On average, OOP costs were
$304 for a first trimester surgical
Women typically pay
abortion, $365 for a first-trimester
70-80% of the total
medication abortion, $638 for an
cost for an abortion at
abortion 14-19 weeks, and $656
less than 20 weeks
for an abortion 20 weeks and
over. Women paid 70-80% of the
total costs for an abortion less than 20 weeks and about 35% of
the total costs for abortions over 20 weeks. When women are
covered for abortion services, studies show the majority pay $20
or less in OOP costs17.
For many women, especially the 42% reporting incomes below
the federal poverty level, paying for an abortion represents a
substantial cost. Roberts et al specifically asked women how
their abortion costs compared to their income, and 56% said
OOP costs were more than one-third of their monthly personal
income17. Abortion OOP costs have also been shown to be
higher than other typical health care expenses for individuals
aged 25-34, who are more likely to be uninsured and seek
abortion care18. Phillips et al, using nationally representative
data from a government survey, showed that the median OOP
cost for a first trimester medication abortion ($440) was nearly
twice the annual median OOP cost for health care ($258)18. This
difference between median OOP cost is even more striking for
abortions beyond the first trimester but less than 20 weeks (~3
times higher) and 20 weeks or higher (~7 times higher).
Determinants of abortion OOP costs in the United States
Several articles in our review described factors contributing to
OOP costs for abortion services at the policy, provider, and
individual level.
At the policy level: Insurance coverage of abortion—unlike
other health care services—is determined by laws at both the
federal and state level. The Hyde Amendment, included yearly
in appropriations legislation, specifies federal funds cannot be
used to cover abortions for those enrolled in Medicaid unless
the woman’s life is in danger, or the pregnancy is a result of rape
or incest. Over the years, politicians added this language into
further legislation to deny coverage to federal employees and
their dependents, military service members, Native Americans,
Peace Corps volunteers and others19. Currently, 32 states and
the District of Columbia follow the specifications of the
Hyde Amendment8. Remaining
states use state-only funds to
7.4 million women live
extend abortion coverage for
in states that restrict
women on Medicaid beyond
abortion coverage in
the federal limitations of the
accordance with the
Hyde Amendment. Restrictions
Hyde Amendment
within the Affordable Care Act
(ACA) have effectively limited
abortion coverage in plans included in ACA health insurance
exchanges20. As of 2016, women residing in 31 states cannot find
insurance coverage for abortion care through a plan offered on
health exchanges8. Six of these 31 states do not offer plans that
include abortion coverage, while the remaining 25 states have
enacted laws prohibiting all plans in their state marketplace from
covering abortion8. For women residing in one of the remaining
19 states with a plan that covers abortion, coverage may still be
absent, as the availability of these plans varies by county8. While
some states have chosen to extend the ban on abortion coverage
to private plans, other states have further narrowed the reasons
under which a woman is permitted to have her abortion covered
under a private plan8. These variations in coverage add to the
complexity for women seeking abortion coverage and access.
At the health care provider level: Three qualitative studies
have documented the burden that health care providers face
in 12 states where Medicaid only covers abortion based on the
Hyde exceptions. Providers described significant challenges
receiving and/or applying for Medicaid reimbursement when a
woman’s procedure qualified for coverage based on the eligible
Hyde exceptions. In two studies, disagreements around the
interpretation of “life-endangerment”11, 21 and “rape”11, 21 and
difficulties identifying and documenting rape cases by staff in
state Medicaid offices11 were cited as reasons the clinic did not
receive reimbursement for abortion services that should have
qualified for Medicaid funding11,21.
“We [providers]….may believe an abortion is necessary to save the
life of a pregnant woman. Oftentimes, when it goes to Medicaid,
they don’t agree with that assessment.”21
Providers and administrative staff at clinics also cited significant
bureaucratic paperwork, extensive staff time to complete the
paperwork, and delays in communication from the Medicaid
office as reasons the clinic did not receive reimbursement11,21,22.
The burden of working with Medicaid became an impenetrable
barrier for some, to the extent that some providers stopped
working with Medicaid.
“We cannot get a Medicaid referral because we are not a Medicaid
provider, but we are not a Medicaid provider because they seldom
ever pay for abortions.”11
Together, these reimbursement challenges contribute to OOP
costs for low-income women, as they now have fewer providers
that will accept their insurance.
At the individual level: Even in states with Medicaid coverage
of abortion, approximately eight percent of women who
2
would be eligible for Medicaid do not obtain coverage for
their abortion, likely a result of challenges associated with
recognizing eligibility and enrollment into Medicaid23. Women
reported conversations with Medicaid staff and insurance plan
representatives where the staff/representatives were uncertain or
did not clearly explain abortion coverage under their insurance
plans24,25. Additionally, Medicaid staff provided information
that contradicted state or federal policy25. As a result, in some
cases women do not end up using their insurance to cover their
abortion because they do not think the procedure is covered by
their plan6.
Similar to the challenges health care providers face, women who
seek insurance coverage when they qualify based on the Hyde
exceptions experience delays in care due to differing definitions
of rape and life endangerment. Women are often asked to
provide supporting documentation as proof their abortion
meets the criteria for coverage, while the conflicting definitions
and interpretations of the coverage restrictions often make it
unclear which documents need to be submitted11,21,25.
Other delays in care are related to complications and confusion
with the Medicaid enrollment process26. For example, in a study
of women seeking state-subsidized insurance for abortion
care in Massachusetts—one of the seventeen states that cover
abortion with state funds—women reported that the state
insurance system was complicated and confusing, and said that
delays in the enrollment process were often due to errors and
missing forms or documents26. These delays not only impact
the types of abortion procedures a woman can choose (because
medication abortion is only available early in pregnancy), but
also lead to increased OOP costs for women unable to secure
coverage in time for an earlier procedure who then get a later,
costlier, procedure26.
Finally, stigma associated with abortion leads some women
to choose to pay OOP for their abortion rather than using
insurance. In a qualitative study by Dennis et al, women reported
opting to pay OOP due to fear of someone finding out about
the abortion. In one case, a young woman, who relied on
insurance from a parent, paid OOP to avoid a parent finding out
about the abortion10.
Impact of abortion OOP costs
The majority of women seeking an abortion in the last year had
reported experiencing one or more disruptive events, such as
being unemployed or falling behind on their rent or mortgage27.
Abortions are unexpected events and for women already
struggling to make ends meet, abortion health expenditures at an
average OOP cost of $365 are catastrophic. A 24-year old nonHispanic White woman summed it up best when she said:
“I know a lot of people that have had an abortion. Most of my
friends and a lot of my family members have. I just know that every
time I know somebody who has to go through that, it’s a struggle
having to come up with the money because they’re very rarely covered
by health insurance. So, even my friends that have insurance still
have to pay out-of-pocket for their abortions, and you know it’s
unexpected. I mean women don’t know that they’re going to have to
have one, we don’t plan for that. We don’t put away a fund for it or
anything. So it’s really an unexpected expense, and I know a lot of
people that have been really burdened by it.”10
A review of funding provided by the National Network of
Abortion Funds to 2959 US women between 2010-2014
showed that women were generally able to raise less than onequarter of the cost of an average abortion12. The search for
financial resources to pay OOP costs can delay women from
obtaining abortion care, forcing some women to have later
abortions and increasing the costs and potential health risks
of an unintended pregnancy28,29. To afford care, some women
endure financial hardships such as forgoing food or schooling,
forgoing work, taking out payday or other loans, delaying bills
or rent, putting large amounts on credit cards, and pawning
belongings10,16,17,21,30-34. One 27-year old, low-income, Black
woman described her path to finding funding for her abortion:
“I did a payday loan against my [pay] check. Some bills did not get
paid. […]. I didn’t send my daughter to preschool. […] whatever
money I had to pay for other stuff, I was trying to save and hustle it.
I actually pawned some of my jewelry as well.”10
For some women, the cost of an abortion extends beyond $365
for a clinic based abortion and includes secondary costs such as
lost wages (~ $198), hotel costs (~$140), and childcare (~$57)6.
Furthermore, because some states prohibit abortions after
certain gestational ages, women who are delayed due to financial
reasons may have to travel to states that permit later abortions;
this leads to additional costs and burdens6,28,35-38.
Extant literature reports that in the absence of Medicaid
assistance, one in four low income women who desire an
abortion are forced to carry their pregnancies to term39. Studies
on the experience and outcomes of unintended or unwanted
pregnancies show that, even in circumstances of adequate
economic resources, women and children are more likely to
experience poorer birth outcomes such as low birth weight40
and poorer social and psychological outcomes including lower
self-esteem, lower educational attainment, and more behavioral
issues during adolescence41-44. Results from the Turnaway study
show that women denied an abortion were three times more
likely to end up below the federal poverty line two years later45.
In contrast, ensuring abortion access enabled women to achieve
aspirational goals related to education, employment, and change
in residence46.
Addressing the burden of high OOP costs
In the face of high OOP costs, half of all women seeking
abortions rely on assistance from other sources to cover their
abortion6. One such source is abortion funds—grassroots
organizations that help fill the “payment gap” for some abortion
seekers. In a random sampling of 9493 women who obtained
an abortion in the United States in 2008, 13% reported relying
on financial assistance programs such as abortion funds to
3
cover service costs7. More
recent survey results not only
Median OOP cost for a
show similar proportions of
first trimester abortion
abortion patients receiving
is 2x the annual median
financial assistance, but also note
OOP cost for other
an increase in funding requests
health care
from women at later gestational
ages, suggesting that despite
the promises of better comprehensive coverage through health
care reform, barriers to abortion coverage push women later
into a pregnancy and result in an increased need for informal
sector funding12. Beyond providing financial assistance, abortion
funds can act as an important source of information about
and referrals to subsidized health insurance in states that use
their own funds to cover abortion costs. Many women referred
by Massachusetts abortion funds to state-subsidized health
insurance characterized abortion funds as a “helpful gateway” to
insurance enrollment47. Of note, abortion funds are dependent
on donations and because of limited funding they are not able to
cover all women seeking assistance. As a result, many funds are
forced to prioritize each case based on need or the complexity or
cost of the procedure12.
A number of other indirect and ad hoc solutions involve
“work-arounds” for the Medicaid reimbursement process. In
one study, providers mentioned that they involved clients in
the reimbursement process by having them contact Medicaid
and ask why a qualifying abortion wasn’t being covered. While
participating in the reimbursement process may be empowering
for some women, other women “feel overwhelmed or further
victimized by the process”22. Some clinics have worked to
build relationships with the Medicaid staff to help smooth
the reimbursement and billing process, with the downside of
diverting staff time from patient care and other priorities22, while
others “eat the cost” of the procedure by providing discounted
services and sometimes suffered financially for it21. Neither the
current direct nor indirect solutions are ideal or sustainable.
Advocating for improved abortion care access
Abortion care is a key component of comprehensive women’s
reproductive health care. However, the cost of an abortion is a
major hurdle for women seeking them. This barrier is even more
insurmountable for women living below the federal poverty
line, who rely on federal assistance for their health care needs.
Women have a right to good reproductive and sexual health and
that means having access to the care they need, where and when
they need it.
To improve women’s abortion care access and promote the
health and wellbeing of women and their families, the availability
of abortion services and coverage for abortion care must be
expanded. Public health and policy strategies that reduce OOP
costs will be crucial to this expansion effort and must address
root causes such as prohibitions on coverage, low insurance
reimbursement rates, and abortion stigma.
1. Lift restrictions that deny health coverage of abortion
services through public and private insurance
a. At the federal level, the passage of the Equal Access to
Abortion Coverage in Health Insurance (EACH Woman)
Act of 2015 (H.R.2972) would ensure that a woman’s
decision about abortion is not based on her income, how
she is insured, or where she lives. This legislation ensures
that if a woman gets her care or insurance through the
federal government, she will be covered for all pregnancyrelated care, including abortion. The EACH Woman Act
also prohibits political interference with decisions of private
health insurance companies to offer coverage for abortion
care. Federal, state, and local legislators will not be able
to interfere with the private insurance market to prevent
insurance companies from providing abortion coverage.
b. Also, we recommend the 35 states that deny Medicaid
coverage from their citizens insured by the state’s Medicaid
program to begin using their own funds to cover this care.
Although abortion funds fill a critical gap in the US health
care system caused by funding restrictions such as the Hyde
Amendment, these funds cannot meet the needs of all
women.
2. Address the challenge of access and provision of
services related to enrollment complexities and varied
interpretations around eligibility for Medicaid
a. Where there is coverage of abortion care (full or limited), a
better understanding of Medicaid processes and definitions
related to abortion coverage will reduce uncertainty in cases
that meet the criteria and therefore can be covered. This
improvement in knowledge will help reduce the numbers
of women paying OOP, while increasing the numbers of
providers getting reimbursed for abortion services.
b. A 2016 Kaiser Family Foundation report states that 29%
of currently uninsured women could enroll in a Medicaid
or private insurance plan that does not limit the scope
of coverage for abortion services8. However, given the
reported complexity of the enrollment process, it is likely
that a portion of these women who could enroll will not.
Simplifying the Medicaid enrollment process will remove
this barrier for women eligible for coverage.
3. Address concerns with privacy for abortion care services
a. Instituting state-level insurance statutes and regulations
that prevent policyholders from being notified if insurance
is used for an abortion or prevent an abortion from being
listed on their insurance will alleviate women’s concerns
about the privacy of their health information.
b. Increasing funding for and dissemination of public health
initiatives that target abortion stigma may help empower
women, fearful of ‘abortion outing’, with coverage to use
that benefit.
4
Conclusion
Accessing abortion care services is costly for women in the
United States. Since the average American cannot come up with
$400 to cover unexpected health expenditures, the OOP costs
for an abortion are likely to have a significant impact on the
financial security of women seeking an abortion. Addressing
barriers related to access such as cost is imperative to protecting
women’s reproductive health and will help to bolster associated
socioeconomic outcomes such as educational attainment and job
participation.
References
1) Squires D, Anderson C. U.S. health care from a global perspective: spending,
use of services, prices, and health in 13 countries. The Commonwealth Fund.
2015;15.
2) Larrimore J, Arthur-Bentil M, Dodini S, Thomas L. Report on the economic
well-being of U.S. households in 2014: Board of Governors of the Federal
Reserve 2015 May.
3) Piette JD, Heisler M, Wagner T. Problems paying out-of-pocket medication costs
among older adults with diabetes. Diabetes Care. 2004;27:384-91.
4) Hirth RA, Greer SL, Albert JM, Young EM, Piette JD. Out-of-pocket spending
and medication adherence among dialysis patients in twelve countries. Health
Affairs. 2008;27(1):89-102.
5) Collins SR, Rasmussen PW, Doty MM, Beutel S. Too high a price: out-of-pocket
health care costs in the United States. Findings from the Commonwealth Fund
Health Care Affordability Tracking Survey. September-October 2014. Issue Brief
(Common Fund). 2014 Nov;29:1-11.
6) Jones RK, Upadhyay UD, Weitz TA. At what cost? Payment for abortion care by
U.S. women. Women’s health issues : official publication of the Jacobs Institute
of Women’s Health. 2013 May-Jun;23(3):e173-8.
7) Jones RK, Finer LB, Singh S. Characteristics of US abortion patients, 2008. New
York: Guttmacher Institute 2010.
8) Salganicoff A, Sobel L, Kurani N, Gomez I. Coverage for Abortion Services in
Medicaid, Marketplace Plans and Private Plans Menlo Park, CA: The Henry J.
Kaiser Family Foundation 2016.
21) Dennis A, Blanchard K. Abortion providers’ experiences with Medicaid abortion
coverage policies: a qualitative multistate study. Health services research. 2013
Feb;48(1):236-52.
22) Dennis A, Blanchard K, Cordova D. Strategies for securing funding for
abortion under the Hyde Amendment: a multistate study of abortion providers’
experiences managing Medicaid. American journal of public health. 2011
Nov;101(11):2124-9.
23) Guttmacher Institute. How do women pay for abortions? 2013.
24) Pluff L, Waligora K, Hasselbacher L. Coverage of contraception and abortion in
Illinois’ qualified health plans. EverThrive Illinois and the Univ. of Chicago. 2015.
25) Dennis A, Blanchard K. A mystery caller evaluation of Medicaid staff responses
about state coverage of abortion care. Women’s health issues : official publication
of the Jacobs Institute of Women’s Health. 2012 Mar;22(2):e143-8.
26) Bessett D, Gorski K, Jinadasa D, Ostrow M, Peterson MJ. Out of time and out
of pocket: experiences of women seeking state-subsidized insurance for abortion
care in Massachusetts. Women’s health issues : official publication of the Jacobs
Institute of Women’s Health. 2011 May-Jun;21(3 Suppl):S21-5.
27) Jones RK, Jerman J. Time to Appointment and Delays in Accessing Care Among
U.S. Abortion Patients. New York: Guttmacher Institute 2016.
28) Drey EA, Foster DG, Jackson RA, Lee SJ, Cardenas LH, Darney PD. Risk factors
associated with presenting for abortion in the second trimester. Obstetrics and
gynecology. 2006 Jan;107(1):128-35.
29) Upadhyay UD, Weitz TA, Jones RK, Barar RE, Foster DG. Denial of abortion
because of provider gestational age limits in the United States. American journal
of public health. 2014;104(9):1687-94.
30) Center for Reproductive Rights. Whose Choice? How the Hyde Amendment
Harms Women. New York, NY 2010.
31) Jewell RT, Brown RW. An economic analysis of abortion: The effect of travel
cost on teenagers. Social Science Journal. 2000 2000;37(1):113-24.
32) Reproductive Health Technologies Project. Two Sides of the Same Coin:
Integrating Economic and Reproductive Justice. Washington, DC 2015.
33) Wiebe ER, Janssen P. Time lost from work among women choosing medical or
surgical abortions. Women’s Health Issue. 2000;10(6):327-3.
34) Van Bebber SL, Phillips KA, Weitz TA, Gould H, Stewart F. Patient costs for
medication abortion: Results from a study of five clinical practices. Women’s
Health Issues. 2006;16(1):4-13.
35) Jones RK, Jerman J. Abortion incidence and service availability in the United
States, 2011. Perspectives on sexual and reproductive health. 2014 Mar;46(1):3-14.
9) Jerman J, Jones RK, Onda T. Characteristics of U.S. abortion patients in 2014
and changes since 2008. New York: Guttmacher Institute 2016.
36) Ely G, Jackson D, Hales T, Maguin E, Hamilton G. Where are they from and
how far must they go? Examining location and travel distance in patients
receiving pledges for abortion funding.
10) Dennis A, Manski R, Blanchard K. Does Medicaid coverage matter?: A
qualitative multi-state study of abortion affordability for low-income women.
Journal of health care for the poor and underserved. 2014 Nov;25(4):1571-85.
37) Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Timing of steps
and reasons for delays in obtaining abortions in the United States. Contraception.
2006 Oct;74(4):334-44.
11) Kacanek D, Dennis A, Miller K, Blanchard K. Medicaid funding for abortion:
providers’ experiences with cases involving rape, incest and life endangerment.
Perspectives on sexual and reproductive health. 2010 Jun;42(2):79-86.
38) Gerdts C, Fuentes L, Grossman D, White K, Keefe-Oates B, Baum SE, et
al. Impact of Clinic Closures on Women Obtaining Abortion Services After
Implementation of a Restrictive Law in Texas. American journal of public health.
2016 Mar 17:e1-e8.
12) Ely G, Jackson D, Hales T, Maguin E, Hamilton G. The Undue Burden of Paying
for Abortion: An Examination of Abortion Funding Assistance Cases in the
United States. Sexual Health.
13) Jerman J, Jones RK. Secondary measures of access to abortion services in
the United States, 2011 and 2012: gestational age limits, cost, and harassment.
Women’s health issues : official publication of the Jacobs Institute of Women’s
Health. 2014 Jul-Aug;24(4):e419-24.
14) Jones RK, Kooistra K. Abortion incidence and access to services in the United
States, 2008. Perspectives on sexual and reproductive health. 2011 Mar;43(1):41-50.
15) Jones RK, Zolna MR, Henshaw SK, Finer LB. Abortion in the United States:
incidence and access to services, 2005. Perspectives on sexual and reproductive
health. 2008 Mar;40(1):6-16.
16) Nickerson A, Manski R, Dennis A. A qualitative investigation of low-income
abortion clients’ attitudes toward public funding for abortion. Women & health.
2014;54(7):672-86.
17) Roberts SC, Gould H, Kimport K, Weitz TA, Foster DG. Out-of-pocket costs and
insurance coverage for abortion in the United States. Women’s health issues: official
publication of the Jacobs Institute of Women’s Health. 2014 Mar-Apr;24(2):e211-8.
18) Phillips KA, Grossman D, Weitz TA, Trussell J. Bringing evidence to the debate
on abortion coverage in health reform legislation: findings from a national survey
in the United States. Contraception. 2010;82(2):129-30.
19) The National Women’s Law Center. The Hyde Amendment Creates an
Unacceptable Barrier To Women Getting Abortions [Fact Sheet]. 2015.
20) Salganicoff A, Sobel L. Abortion Coverage in Marketplace Plans, 2015. Menlo
Park, CA: The Henry J. Kaiser Family Foundation 2015.
39) Henshaw SKea. Restrictions on Medicaid Funding for Abortions: A Literature
Review. New York: Guttmacher Institute 2009.
40) Mosher WD, Jones J, Abma JC. Intended and unintended births in the United
States: 1982-2010. Natl Health Stat Report. [Research Support, N.I.H.,
Extramural Research Support, U.S. Gov’t, P.H.S.]. 2012 Jul 24(55):1-28.
41) David HP. Born Unwanted: Long-Term Developmental Effects of Denied
Abortion. Journal of Social Issues. 1992 October 1992;48(3):163-81.
42) Axinn WG, Barber JS, Thornton A. The long-term impact of parents’
childbearing decisions on children’s self-esteem. Demography. [Research Support,
U.S. Gov’t, P.H.S.]. 1998 Nov;35(4):435-43.
43) Joyce TJ, Kaestner R, Korenman S. The effect of pregnancy intention on child
development. Demography. 2000 Feb;37(1):83-94.
44) Hay C, Evans MM. Has Roe v. Wade Reduced U.S. Crime Rates? Examining the
Link Between Mothers’ Pregnancy Intentions and Children’s Later Involvement
in Law-Violating Behavior. Journal of Research in Crime and Delinquency.
2006;43(1):36-66.
45) DG F. Socioeconomic consequences of abortion compared to unwanted birth.
American Public Health Assoc. annual meeting; Oct.27–31, 2012; San Francisco.
46) Upadhyay UD, Biggs MA, Foster DG. The effect of abortion on having and
achieving aspirational one-year plans. BMC Women’s Health. 2015;15:102.
47) Gorski K, Bessett D. Experiences of Women Seeking State-Subsidized Insurance
for Abortion Care in Massachusetts: An Evaluation by the Massachusetts
Abortion Funds. Cambridge, MA: EMA Fund, an affiliate of the National
Network of Abortion Funds 2011.
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